Laserfiche WebLink
SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICE, ... <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM . FEE WORKSHEET <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br /> F M, s i'e�IC�C �-L+Tto�*-]'f'- ?-= <br /> A <br /> C SITE PHONE a with AREA CODE <br /> I FACILITY ADDRESSa1 1 ,1 �.. CR _. <br /> - l 'J7iZg W�vT N "t <br /> I STATE ZIP CODE # of TANKS ,1 <br /> T CI�To�T — 1 at SITE "T <br /> G�`i APPLICANT CONTACT NAME - <br /> A APPLICANT/BILLING NAME <br /> P Inc til- �' L�—�c �OGIe T✓� b'`cC vR�C4� <br /> P <br /> L APPLICANT PHONE k WITH AREA CODE <br /> 1 MAILING ADDRESS <br /> C <br /> A STATE ZIP CODE TYPE of APRLI CAT ION <br /> T (..-T Gp, oJ39 CLOSURE, INSTALLATION, etc <br /> A 1986 1987 1988ETTAL <br /> C <br /> 1 ANNUAL FACILITY FEE (Prior to January 1, 1991) - SIDO.00 - <br /> I <br /> V 5170/TANK (after January 1, 1991) <br /> E TANK FEE = S50.00/TANK (prior to January 1,1991) <br /> F a Tanks 1986 1987 1988 1989 1990 1991 1992 1993 1996 1995 1996 <br /> A (multiply k by fee for S <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H d S Code, Section 2528 <br /> 1 1991 through 1996 <br /> T A Tenks A 556.00 1986 through 1990 <br /> T (enter amount and year) S <br /> MPERMANENTCLOSUREURE (Removal or Authorized C l osure-in•PLOCO) TANK I.D. a(s) <br /> K 1159.00S53.00 per hour (3 hours minimum per TANK) R TANK(s)_� -(1�.� SSURE (A one-time permit, for review/inspeCtioru) TANK I.D. R(s) <br /> 9 1ANK(s) __ A 5150.00 S <br /> SURE FEE - 1150.00 each TANK <br /> P PLAN CHECK (Install. Plan Review d Construction Inspections) TANK I.D. A'(s) <br /> L <br /> A 5426.00 minimm S <br /> N PLAN CHECK FEE - S53.00 per hour (8 hours minimum per Facility) <br /> R REPAIR FEE (workplar�'Faview d construction inspections) TANK I.D. *(S) <br /> — <br /> E 0 TANK(s) K $159.00 = S <br /> P TANK REPAIR FEE - S53.00 per hour (3 hours minlmndTANK) <br /> A <br /> 1 = E159.00) S <br /> R PIPING REPAIR FEE = $53.00 per hour (3 hour minimum per facility <br /> MTRANSFER FEE <br /> = S20.00 UNAUTHORIZED RELEASE EVALUATION 553.00/hr S <br /> I <br /> SS <br /> C CONSULTATION FEE = S53.00/hr SAMPLING INSPECTION FEE = S53.00/hr <br /> TOTAL DUE 1 <br /> OFFICE USE ONLY _ ___ ...__.._.__..--...._......_...._...._.._......_..._._......._.._....__..__._.... <br /> a QSE�`S�Rr O�iP�IL CCS " 5�'=CCb ^� dC1)�"'`� F. �CA�F� <br /> a <br /> a <br /> l 1�� 'l rrYr u=rrlrM ly=aCa Yi rYYYIY 'l r1r�=rfrlID O��r lY<lrl rY/Or <br /> Oi lf�s=ilPrPriaa a4Y <br /> EN 23 032 (REV 6/8/911 it -- Peoe 11 <br />